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目的:研究重症慢性阻塞性肺疾病(COPD)患者入院12 h乳酸清除率、急性生理与慢性健康(APACHEⅡ)评分与患者预后的关系。方法:对本院重症监护病房收治的103例重症COPD患者的住院资料、预后情况进行统计分析,根据患者的入院24 h APACHEⅡ评分、12 h乳酸清除率进行分组,探讨APACHEⅡ评分、12 h乳酸清除率与患者预后的关系。结果:APACHEⅡ评分≤20分组的预后效果较好,其死亡率为8.33%,显著低于21~30分组的32.81%和≥31分组的73.33%(均P<0.05),21~30分组的死亡率显著低于≥31分组(P<0.05);治疗12 h后的Pa CO2、入住ICU时以及治疗12 h后的血乳酸水平、机械通气治疗时间APACHEⅡ评分≤20分组均显著低于21~30分组和≥31分组(均P<0.05)。高清除率组死亡率为19.05%,显著低于低清除率组的42.62%(P<0.05);治疗12 h后的Pa CO2、入住ICU时及治疗12 h后的血乳酸水平、机械通气治疗时间高清除率组均显著低于低清除率组(均P<0.05),而Pa O2水平高清除率组显著高于低清除率组(P<0.05)。结论:根据患者入住ICU 12 h的血乳酸清除率、24 h APACHEⅡ评分情况可以对重症COPD患者的预后情况进行预测,因此临床中应密切关注这两项指标,并及时调整治疗措施。
Objective: To study the relationship between lactic acid clearance, acute physiology and chronic health (APACHEⅡ) score and the prognosis of patients with severe chronic obstructive pulmonary disease (COPD) at admission 12 h. Methods: The hospitalization data and prognosis of 103 patients with severe COPD admitted to our hospital were analyzed statistically. According to APACHEⅡscore 24 h and lactic acid clearance 12 h after admission, APACHEⅡscore, lactic acid clearance 12 h Relationship between rate and patient prognosis. Results: The prognosis of patients with APACHEⅡ score ≤20 was good, with a mortality rate of 8.33%, significantly lower than 32.81% of 21-30 patients and 73.33% of ≥31 patients (all P <0.05), and deaths of 21-30 patients (P <0.05). PaCO 2 at 12 h after treatment, blood lactic acid concentration at ICU admission and after 12 h of treatment, APACHEⅡ score ≤20 in mechanical ventilation treatment time were all significantly lower than those in 21-30 Grouping and ≥31 groups (all P <0.05). The mortality rate of high-clearing rate group was 19.05%, which was significantly lower than that of low-clearing rate group (42.62%, P <0.05); PaCO 2 after 12 h, blood lactic acid concentration after ICU admission and 12 h after treatment, (P <0.05), while the PaO2 level of high-clearance group was significantly higher than the low-clearance group (P <0.05). Conclusion: The prognosis of patients with severe COPD can be predicted based on the blood lactic acid clearance rate of 12 h admitted to ICU and the APACHE II score of 24 h. Therefore, these two indicators should be closely monitored and the treatment measures should be adjusted in time.